原发性小肠肿瘤的诊断和治疗

目的 探讨原发性小肠肿瘤的诊断及治疗。方法 回顾性分析近17年来收治并经过手术及病理确诊的65例原发性小肠肿瘤的临床资料、诊断及治疗情况。结果 肿瘤位于十二指肠25例(38．5％)，空肠16例(24．6％)，回肠24例(36.9％)，其中恶性肿瘤47例(72．3％)，良性18例(27．7％)。本组常见症状为腹痛(70．7％)，消化道出血(46．2％)和腹部肿块(13．8％)。术前误诊率为36．9％，其中空回肠肿瘤误诊率为59．5％。65例均手术治疗，手术后死亡2例。随访恶性肿瘤患者1，3，5年生存率分别为65．8％，42．1％，20．3％。结论 小肠肿瘤缺乏特异性症状和体征，术前误诊率高。对有出血、腹痛、梗阻、包块等临床表现者应怀疑本病可能；对诊断不明者，应综合采用各项检查，必要时剖腹探查。治疗应以手术切除为主，恶性肿瘤应加以化疗。     

原发性小肠恶性肿瘤的早期诊断

目的探讨原发性小肠恶性肿瘤疾病的早期诊断方法。方法回顾性总结和分析临床16例原发性小肠恶性肿瘤患者的临床资料。结果肿瘤位于十二指肠9例，位于空肠3例，位于回肠4例。术前得以确诊10例，确诊率为62．5％，内镜诊断十二指肠肿瘤阳性率高。对位于空回肠肿瘤以小肠钡剂灌肠的价值最高，阳性率达80％以上。消化道梗阻和（或）腹部包块在半数以上病例中出现。结论原发性小肠恶性肿瘤无特异性临床早期表现，提高对该疾病的早期认识，恰当的术前检查方法，对疾病的早期诊断有较大帮助，对高度疑似病例可放宽剖腹探查指征。     

原发性十二指肠腺癌的外科治疗

目的探讨原发性十二指肠腺癌生物学特征及外科治疗问题。方法回顾性分析近20年31例十二指肠腺癌患者临床资料。结果13例术前胃镜检查，12例发现病变，诊断丰92．3％；上消化道钡餐13例，阳性发现IO例，诊断率76．92％。胰十二指肠切除17例，十二指肠节段切除5例，姑息性旁路手术9例。手术切除率70．98％，近期合并症12．9％。肿瘤侵犯十H指肠壁全层及胰腺组织15例（68．18％），淋巴结转移率500％（11／22）。9例姑息性手术，8例1年内死亡，l例存活2年4个月。17例胰十二指肠切除者，随诊2年发现肝转移6例，其中4例初次手术淋巴结转移。5例十二指肠节段切除者，2例失访，2例肿瘤1年内复发死亡，l例死于非肿瘤疾病。结论十二指肠癌病变隐匿，恶性程度较高，早期诊断及选择根治性的切除手术有望提高临床治疗效果。     

成人小肠肿瘤36例临床分析

目的探讨小肠肿瘤的临床特点及其诊断方法。方法对2000年1月至2009年1月诊治的36例小肠肿瘤的临床资料进行回顾性分析。结果36例中,良性肿瘤8例,恶性肿瘤28例。肿瘤位于十二指肠者13例,空肠11例,回肠12例。较常见临床表现为腹痛、腹部肿块、消化道出血、肠梗阻、黄疸、体重减轻等。术前诊断率为41．7％;B型超声、CT诊断符合率较低,胶囊内镜、泛影葡胺全消化道造影及数字减影血管造影（DSA）检查有助于确定病变的部位及性质。28例恶性肿瘤根治性切除率为46．4％。结论小肠肿瘤临床表现不典型,恶性肿瘤早期诊断极为困难,应加强对本病的重视和认识,以改善病人预后。     

85例原发性空回肠肿瘤临床分析

目的：总结原发性空回肠肿瘤的临床病理特点,提高诊治水平。方法：回顾性分析我院近10年来85例原发性空回肠肿瘤的临床资料及随访结果。结果：良性肿瘤22例,恶性肿瘤63例,良恶性之比为1∶2.9。恶性肿瘤主要包括腺癌（22例）、恶性间质瘤（20例）、淋巴瘤（16例）等,恶性肿瘤的直径大于良性肿瘤。隐性失血、脐周隐痛与腹部包块是小肠肿瘤最常见的症状,亦是其早期诊断的警示信号。小肠肿瘤的术前确诊率为41.2%（35/85）,空肠肿瘤确诊率51.4%（19/37）,回肠33.3%（16/48）。22例良性肿瘤行局部或肠段切除;63例恶性肿瘤中,32例行肿瘤根治、转移病灶切除,26例行姑息性切除或减瘤荷手术,5例行短路手术。本组恶性肿瘤1、3、5年的生存率分别为80.3%、47.8%、33.8%。结论：B超、CT结合内窥镜检查是小肠肿瘤的主要诊断手段,术中冰冻、肿瘤大小有助于小肠肿瘤性质的判断,争取根治性手术是改善预后的关键。     

十二指肠损伤35例外科治疗体会

目的：探讨十二指肠损伤的外科治疗手术方式及效果。方法：回顾分析1998年3月—2008年3月手术治疗的35例十二指肠损伤患者的临床资料。结果：十二指肠损伤术前诊断率低,为17.1%（6/35）;合并其他脏器损伤率高,占71.4%（25/35）。手术方式：单纯修补造瘘10例,端端吻合或与空肠侧侧吻合3例,十二指肠空肠Roux-en-Y吻合3例,浆膜覆盖及带蒂空肠片移植修补8例,十二指肠憩室化手术8例,胰十二指肠切除3例。十二肠损伤术后并发症发生率及死亡率较高,本组死亡5例（14.3%）。结论：十二指肠损伤的外科处理关键应根据其损伤情况综合判断,选择合理术式及治疗策略。     

闭合性十二指肠损伤29例外科治疗体会

目的探讨闭合性十二指肠损伤的外科治疗方式及效果。方法回顾分析1997年4月至2009年4月手术治疗的29例闭合性十二指肠损伤患者的临床资料。结果十二指肠损伤术前诊断率低,为20.7%（6/29）;合并其他脏器损伤率高,占75.9%（22/29）。手术方式：单纯修补造瘘13例,端端吻合或与空肠侧侧吻合2例,十二指肠空肠Roux-en-Y吻合6例,浆膜覆盖及带蒂空肠片移植修补2例,十二指肠憩室化手术5例,胰十二指肠切除1例。十二指肠损伤术后并发症发生率及死亡率较高,本组死亡4例（13.8%）。结论十二指肠损伤的外科处理关键是早期诊断、选择合适的术式及充分的十二指肠引流。     

小肠间质瘤21例临床分析

目的：探讨小肠间质瘤的临床表现、诊断及治疗方法。 方法：回顾性分析收治的21例小肠间质瘤的临床资料。 结果：肿瘤位于十二指肠3例,空肠12例,回肠6例。主要临床表现为黑便、腹痛、腹部肿块、腹部不适、贫血等。术前确诊14例。本组均手术治疗,行胰十二指肠切除1例,小肠部分切除18例,小肠部分切除加肝部分切除2例。术后复发3例,1例腹腔广泛转移,1例局部复发并肝转移,再次行复发灶及肝转移灶切除,1例术后1.2年死亡,1例术后3年,仍存活。 结论：小肠间质瘤缺乏特异性临床表现,空回肠肿瘤缺乏特异性检查手段,容易误诊,手术是最有效的治疗方法。     

袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖性2型糖尿病患者脂质代谢的影响

目的评价袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖性2型糖尿病患者脂质代谢的影响。方法回顾性分析2009年3月至2010年8月间在四川省攀枝花市中心医院接受袖状胃切除间置回肠的十二指肠空肠旁路手术的29例非肥胖型2型糖尿病患者的临床资料。术后12个月检测总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、胰岛素抵抗指数及糖化血红蛋白（HbAlc）的变化。结果术后12个月时,28例（96．5％）患者血糖得到控制,无需服降糖药,HbAlc从术前的（8．4±1．3）％降至术后的（6．2±0．8）％,另1例血糖亦获改善。25例（86．2％）患者脂质代谢紊乱得到纠正,其中19例术前高胆固醇血症患者中16例（84．2％）术后恢复正常,17例高三酰甘油血症患者中14例（82.3％）恢复正常,12例高密度脂蛋白异常患者中8例（66．6％）恢复正常,16例低密度脂蛋白异常的患者中5例（31．2％）恢复正常;总胆固醇／高密度脂蛋白从术前的5．6±1．2降至术后的2．8±1．0,三酰甘油／高密度脂蛋白从术前的3．2±1.3降至术后的1．5±0．8（均P〈0．01）。结论袖状胃切除间置回肠的十二指肠空肠旁路手术能有效地改善非肥胖型2型糖尿病患者的脂质代谢紊乱。     

原发性小肠肿瘤手术治疗分析

目的 :探讨原发性小肠肿瘤的诊断与治疗方法。方法 :回顾性分析 2 0例原发性小肠肿瘤的临床资料。结果 :2 0例均经手术和病理检查证实诊断。肿瘤位于十二指肠 4例 ,空肠 8例 ,回肠 8例 ,其中恶性肿瘤 7例 ,良性肿瘤 13例。常见的症状为腹痛、消化道出血、肠梗阻和腹部肿块等。术前确诊 8例 (4 0 % ) ,误诊 12例 (60 % )。 2 0例均行手术治疗 ,13例良性肿瘤行肿瘤及局部肠管切除 ,恶性肿瘤行根治性切除术 6例 ,姑息性切除术 1例。无手术死亡病例。结论 :小肠肿瘤早期诊断困难 ,综合各项检查可提高术前诊断 ,手术治疗是首选     

Primary tumors of the small bowel

Primary tumors of the small bowel are uncommon, representing less than 6 per cent of all gastrointestinal tumors and less than 2 per cent of all malignant gastrointestinal tumors. This report concerns a twenty-five year survey of our clinical records from 1946 to 1971 which revealed 140 primary small bowel tumors, excluding periampullary tumors. Fifty-two of the neoplasms (37 per cent) were benign; eighty-eight (63 per cent) were malignant and included twenty-eight adenocarcinomas (31.8 per cent), twenty-four lymphosarcomas (27.3 per cent), nineteen carcinoids (21.6 per cent), and ten leiomyosarcomas (11.4 per cent). The average age at the time of diagnosis was 56.9 years for patients with benign tumors and 55.9 years for those with malignant tumors. The illusive and obscure nature of small bowel tumors is illustrated by the fact that 63.3 per cent of patients with benign lesions and 47.6 per cent of those with malignant lesions had symptoms for more than six months before the diagnosis was made. Bleeding was the most common present complaint in patients with benign neoplasms (52.9 per cent) whereas patients with malignant lesions more often had symptoms of obstruction (50.6 per cent). Most of the benign lesions were located proximally in the small bowel (duodenum, 34.6 per cent; ileum, 11.5 per cent), and most of the malignant lesions were located distally (duodenum, 17.0 per cent; ileum, 61.4 per cent). Treatment of patients with malignant lesions was radical excision whenever possible. Adjunctive radiation therapy was used for those with lymphoma. A second benign or malignant tumor occurred in 42.9 per cent of the patients with primary small bowel tumors. The average period of survival after diagnosis of a malignant small bowel tumor was 5.03 years: for patients with adenocarcinoma, 3.6 years; lymphosarcoma, 1.3 years; carcinoid, 6.8 years; and leiomyosarcoma, 8.3 years.     

Primary tumors of the small intestine

From 1950 through 1984, 48 cases of primary tumors of the small bowel were treated at the First Surgical Clinic of the University, La Sapienza, of Rome. Forty-three were malignant and five were benign tumors: 13 in the duodenum, 16 in the jejunum and 19 in the ileum. Abdominal pain, weight loss and obstruction were the most common complaints at admission. Radiographic studies of the gastrointestinal tract were diagnostic in 48% of patients. Four benign tumors were leiomyoma of the jejunum or ileum, the other benign tumor was a Brunner's adenomatosis of the duodenal bulb. The tumors were adenocarcinomatous in 29% of the cases and 50% of them were located in the duodenum. The five-year survival of patients with adenocarcinoma was 11%. The fourteen lymphomas were distributed evenly throughout the small bowel: 40% of the patients with lymphoma were alive after five years. Malignant smooth muscle tumors were found in the jejunum and ileum, in these cases the five-year survival rate was 50%. All the carcinoid tumors were in the ileum. The best five-year survival rate, 66%, was seen in patients with this type of tumor. In the malignant group, the five-year survival rate after curative resections was 25% in patients with positive nodes and 75% in those without nodal involvement.     

Primary malignant tumors of the small bowel

Primary malignant tumors of the small bowel are uncommon and are often diagnosed at an advanced stage. A 10 year survey (1967 to 1977) of the clinical records at one hospital revealed 39 cases of primary malignant tumors of the small bowel. The most common symptoms were abdominal pain (89.7 percent) and weight loss (77 percent). Six patients presented with complications of enterovesical fistula, bleeding and perforation. Preoperative diagnosis was suspected in 27 cases (69.2 percent). Adenocarcinoma was the most common tumor, followed by carcinoid tumor, lymphoma, leiomyosarcoma and melanoma. The treatment of choice was surgical resection whenever possible. Curative resection was attempted in 25 cases. Adjuvant radiotherapy and chemotherapy was used in four patients with lymphoma. Twenty-seven patients (69.2 percent) are alive from 1 to 6 years after diagnosis and treatment. The 5 year survival rate is 35 percent. Earlier diagnosis is essential if the prognosis for patients with small bowel malignancy is to be improved.     

原发性胃肠道恶性淋巴瘤的诊治

目的:探讨原发性胃肠道恶性淋巴瘤(PGIML)的诊治方法。方法:回顾性分析1995年1月—2010年12月收治的34例原发性胃肠道恶性淋巴瘤患者临床资料。结果:全组男23例,女11例,年龄22～74(平均51.8)岁。均经病理证实为恶性淋巴瘤,原发病灶位于胃24例,肠道10例。24例胃恶性淋巴瘤患者的首发症状为上腹部隐痛不适,8例合并呕血黑便,3例伴有发热;10例肠道淋巴瘤均以腹痛、腹部包块为首发症状,4例伴有黑便,2例有肠梗阻表现,肠穿孔1例。本组24例胃恶性淋巴瘤中,仅5例经术前胃镜病理活检证实;10例肠道恶性淋巴瘤中,仅1例经结肠镜活检确诊,术前确诊率仅17.64%(6/34)。误诊时间2～8(平均4.5)个月。患者均接受手术治疗,其中行根治性肿瘤切除术32例(根治性全胃切除术8例,根治性远端胃大部切除术14例,小肠部分切除术3例,右半结肠切除术6例,根治性直肠切除术1例),姑息性远端胃大部切除术2例。术后31例患者进行了化疗。34例患者免疫组化分型属B淋巴细胞型27例,T淋巴细胞型4例,未分类型3例。全组均获随访,随访时间5～62个月,1,3,5年生存率分别为82.35%,64.71,47.05%。结论:原发性胃肠道恶性淋巴瘤术前确诊率低,胃肠镜及病理活检是术前确诊的主要方法,以手术化疗联合的综合治疗效果良好。     

原发性小肠恶性肿瘤的95例诊治分析

目的探讨原发性小肠恶性肿瘤的临床表现、病理特点及诊治方法。方法回顾性分析2000年1月至2009年12月间收治95例原发性小肠恶性肿瘤的临床、病理和随访资料。结果95例原发小肠恶性肿瘤中以腺癌最常见,其次为问质瘤、淋巴瘤和神经内分泌肿瘤。临床主要表现为非特异性腹痛、腹部不适、腹部肿块、消化道出血、肠梗阻、黄疸等。本组根治性（R0）切除率为61．1％（58／95）,术前诊断率为61．1％（58／95）,随访3～5年,平均存活期（32±15．7）个月。结论原发性小肠恶性肿瘤缺乏特异性临床表现,早期诊断困难,改善预后的关键在于早期诊断和治疗。CT具有较好诊断价值,外科手术仍是唯一可获治愈的手段,化疗和分子靶向治疗在内的综合治疗也扮演了重要角色。     

原发性腹膜后肿瘤71例的诊断和治疗

目的总结原发性腹膜后肿瘤的诊治经验。方法回顾性分析71例原发性腹膜后肿瘤患者的临床表现、病理类型、影像学检查、外科治疗等临床资料。结果71例患者均经手术治疗且诊断经病理证实。其中32例良性肿瘤完整切除31例(96·88%);38例恶性肿瘤完整切除29例(76·32%);1例交界性肿瘤行完整切除。良、恶性肿瘤5年生存率分别为89·29%和20·80%。良、恶性肿瘤术后复发再手术分别为4例(均完整切除)和13例(完整切除10例;部分切除3例)。结论影像学检查对诊断有重要意义。完整切除肿瘤是治疗的关键和影响预后的重要因素。     

63例原发性腹膜后肿瘤的诊断和外科治疗

目的 总结原发性腹膜后肿瘤诊断和外科治疗经验.方法 回顾性分析1990年1月至2007年3月63例经手术治疗且病理证实的原发性腹膜后肿瘤的临床表现、手术治疗、病理类型和随访结果.结果 63例中良性25例,恶性38例.主要临床表现为腹部包块,CT对良恶性判断的约登指数为85%,良性肿瘤完整切除率为88%,恶性肿瘤为68%,联合脏器切除占肿瘤完整切除总数的40%.肿瘤切除程度和病理类型与术后复发密切相关.良、恶性肿瘤完整切除的5年生存率分别为83.6%和27.3%.恶性肿瘤完整切除的患者平均随访36个月(5～168个月),53%局部复发,平均复发时间25个月(3～108个月),恶性肿瘤局部复发再手术完整切除率62.5%.全组有1例术后第1天腹腔内出血死亡.结论 应当重视临床表现争取早期诊断;影像学检查是判断手术范围的重要依据;肿瘤完整切除,必要时联合脏器切除是治疗本病的最佳手段;术后规律复查有助于及早发现复发肿瘤并争取再手术治疗.     

Gastrointestinal stromal tumors. A case of small intestine stromal tumor (SIST) with an uncertain biological aspect

Tumors of the small intestine are relatively rare. The diagnosis is difficult to establish because the symptoms are vague and non-specific. Although the small intestine constitutes 75% of the length and over 90% of the mucosal surface area of the gastrointestinal tract, only 1 to 2% of gastrointestinal malignancies occur in this segment. Metastases are usually present at the time of diagnosis. The outcome of these patients can be improved if the possibility of a malignant small bowel tumor is considered in all cases of unexplained abdominal pain or gastrointestinal bleeding, especially in younger age. Malignant tumors occur with increasing frequency in distal small bowel with a preponderance of malignant lesions in the ileum compared with the jejunum and the duodenum. Adenocarcinoma is the most common tumor of the primary malignant small bowel tumors, followed by carcinoid, lymphoma and leiomyosarcoma. Mesenchymal tumors of the gastrointestinal tract, traditionally regarded as smooth muscle tumors, have demonstrated different cellular differentiations based on immunohistochemical and ultrastructural features. Therefore the terms leiomyoma and leiomyosarcoma have been replaced by a more encompassing term, gastrointestinal stromal tumor (GIST). The majority of GISTs occurs in the stomach; stromal tumors involving the small intestine (SISTs) are far less common but seem to have greater malignant potential. The clinical a case of a small intestinal stromal tumor (SIST), localised in the jejunum and characterised by an uncertain histological aspect, is presented and a review of the literature is made.     

原发性小肠肿瘤的诊断与治疗

目的 探讨小肠肿瘤的临床特点以及影响小肠恶性肿瘤预后的因素。方法 回顾分析1974年－1999年收治的42例原发性小肠肿瘤病例（不包括壶腹周围癌）的临床资料。结果 本组小肠性肿瘤6例中5例为平滑肌瘤,1例为腺瘤;恶性肿瘤36例,其中恶性淋巴瘤17例（47．2％）,腺癌11例（30．6％）,平滑肌肉瘤6例（16．7％）,类癌1例（2．8％）,神经纤维肉瘤1例（2．85）。临床症状无特异性,内镜和消化道钡餐是主要诊断手段。50％的恶性病例在手术时已有远处转移,仅18例（50％）根治性切除。36例获随访。小肠恶性肿瘤患者术后5年生存率为47．3％。远处转移和肿瘤大小对生态率有显著影响。结论 早期诊断、早期治疗是提高小肠恶性肿瘤预后的主要手段,对无远处转移后应争取行根治术。